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:� �� <br /> qPPLICATIO FOR CONSTRUCT��N PERMIT <br /> µ everett <br /> 1� fM E�s�Cn�sn � <br /> CITY OF <br /> everett <br /> BUILUING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> � 259•8810 <br /> 9 ❑ DEMOLITION ❑ COMBINATION U BUILC�ING �MECHANICAL CI PLUMBING ❑ SIGN <br /> � M�n�ooness cirv �_ zm � PNONE <br /> � ONNER nn_ � . <br /> � f�rl!r� 3�✓.L O U0�2� � YY r�r�'ffzU Za-fr� P�ory7-O!�!- <br /> ; ���T MA0.ADORESS GITY <br /> Z PNONE <br /> MLNRECTORDE6qNEP M��LADDNE55 ��TY Z�P <br /> �� 6ENEMLGONTMCTOR M�M1ADDNF55 CIN ZIP• PNONE LICENSEI <br /> � MECM�MIf.II.CONTMCTOR MAIL�ODRE55 CITV ZIP PNONE UGENSE/ <br /> ! /,. /70ir,�, /�D �y ti�cee� I�OHL �7�/!� �l�11�0-1/idn <br /> � P �� pHUNE UCENSE� <br /> VLWBINOCp�T Ci R � L�M�IL�DDNE55 �CITY Z�P <br /> 'i <br /> A <br /> � CIASSOFWOPN <br /> �� ❑ NEW C ADDITION i AISERATION ❑ REPAIR ❑ DEMOLITION I I WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br /> q`ITE/WI�TMVROVEMEMORINTEHq �EM/Oyp2ELOMLQY CONtACTPEA50NANOPNONENO. <br /> � ' GONi��CTPRIGEOFwOIiK• Stl /'�[S � <br /> .� pE9Cp19E WORK�NO50UARE FO01A0E INVq.VED <br /> K�x�,6!/ f�e.r f•. . � D w�.Iri <br /> , rnoro��ousEoveutiona I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> � � p�� �� l a � �'F�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.11LL <br /> �r �*' PROVISIONS OF LAWS AND ORDINANCFS GOVERNING THIS TVPE OF <br /> �{pµDE9GRIPTIONOFFRW'ENTY161/OWNBELOWORATUCMFWRCOPIES� yyORN WILL BE COMPLETED WITH WHE7HER SPECIFIEO HEREIN OR <br /> ��; �� oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> AUTHORITV TO VIOLATE OF CANCEL THE PflOVI510NS OF ANV <br /> OTHER STATE OR LOCAL LAW FEGULATIN6 CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OW�JER OP THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPIICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS lAW 1827 RCW AND 296200 WAC. <br /> � . S�ONATl1REOFCONTRACTORORAUTHORIZED�4ENT OATE <br /> � � ��.�i ���Pd <br /> � !�HQIEGTAUDRE&5 �pp�ICANTSdT'9USP' iSLICENSENO.NIDBUSME55 RME <br /> 3�.za � <br /> �) PIUMlIN6 MECHANICAL <br /> ,� TYR:"1F E�UIPMENT FEE <br /> ►Ip, TYPE OF FIXTURE OR ITEM FEE NO. <br /> � WATER CLOSET(TOILET) � A1C—AMNDL6�NITS—H.P. ' _ <br /> � FORCED AIR SYSTEMS—B.T.U.y8M E.A. <br /> � <br /> ? BATHTUB UNIT HEATERS—B.T.U. M � <br /> J' IAVATORY(WASH BA�IN) ' T— <br /> 1 SHOWER � CLOTHESDRYERS ' <br /> � KITCHEN SINK 8 DISP ; VENTILATION fAN � <br /> { � <br /> '� DISHWASHER � WATER HEA ER � <br /> 'i LAUNORYTRAV � ; <br /> �s CLO'NES WASHER � WOOD STOVE <br /> � METAI FlFEPLACE t CHIMNEY ' <br /> a URI'JAL ' <br /> ; , FIr7EPLACEINSEFT �_ <br /> DRIIIKING FOUNTA�N i <br /> � FLO(:9 DRAIN � HEAT PUMP <br /> � <br /> � GAS PIPING � <br /> BACK��OW PREVENTERS � <br /> HOOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> � <br /> SINK(SERVICE—OAR,ETC.) � � <br /> � <br /> � <br /> � <br /> i <br /> i <br /> � <br /> A, � <br /> ti; � SUB TOTAL 3 '_ <br /> SUB TOTAL S � pERM1T S � — <br /> �+ PERMIT S ' <br /> iTOTAL FEE 5 ' TOTAL FEE $ ' — <br /> ,� PLANCHEGNNUMBER FEE RECEIPTNO. <br /> � Fi10NTfiETBACK REAfl5ET0ACN SIJESETBACN <br /> � UBEZONE LOTAREA VACANTSITE <br /> FEES VALUATION FEE <br /> ❑ VES ❑ NO <br /> BUILDING � <br /> pLLIflI.VGY 1'O.QUWIWxOUNlf6 � <br /> 7ryE Oi CONST.ALLOWABLE TYPE OF CONSi.ACIUAL GRqI� � <br /> PLUMBING ' <br /> "� � <br /> BQEOFBl00. NO.OFSTURIE6 <br /> B�SEMENi MECIIANICAL � SJ � - <br /> ❑ YES ❑ NO � <br /> � <br /> OTHER ' <br /> OCCUPMlCYLOAO FIRESPRNNLERSRF.OD NEIOMTLIMITATION � <br /> U YES ❑ NO STATE BUILOING SURCHARGE _�_ <br /> _ <br /> qEASONFORSPRMK�ERS STATEENE�GVSURCHAFGE ' _ <br /> i <br /> APPLICATIONACG.BY PUNSAPPROVEDBY CITYOFEVEflE7T PUBLICWORI'S � <br /> LOCAL SALES — 6 r ; _ <br /> 3 TAx COUE IS 3105 TOTAL <br /> � <br /> 1 .___._. �..-:.r-�+.,,:,,.-- , : .c�. <br /> f ���• ... ..�•-•:. . ,�::.::r., . , . .. <br /> [}{�A.'197�A1lTf'S1C'�':wu.P.4��1 yrv✓i.li 11,p'u:1 l". l'..1:9e 11. . . . . <br />